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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator v 0 z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> M <br /> OWNER TELEPHONE <br /> MAILING ADDRESS O <br /> `Gl.i f <br /> � (J�lh� /h o <br /> PROPERTY ADDRESS <br /> ( P) �- 3 La CS/-nV/'7 vel S`F�� <br /> LEGAL DESCRIPTION see tax receipt <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ,/ o' <br /> Imo—`f U <br /> a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: <br /> 9 <br /> j/ (Home/Cabin; GZInmerclia usiness; Bedroom; Deck;etc.) N <br /> BUILDING CONTRACTOR: — <br /> � V d <br /> U <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O m <br /> C <br /> nIn <br /> O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. -0 <br /> ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> m �o <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO In v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 2 CS <br /> MUST BE SIGNED AND DATED BY THE OWNER. I --I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN li O <br /> NEEDED. ISJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY CU <br /> PERMITTED. <br /> 4. NO STRUCTURES§,4NCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AR5. f� /� , I <br /> oZ <br /> A Cir o > 0 -0 <br /> 7. <br /> Z N ry O p -t <br /> 1 declare that this application (including any accompanying schedule) has been examine"y me and M the best of my cn p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of uv, c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the County Burnett Wisconsin in determining whether to is- m <br /> sue a permit. I further accept all liability which may b result of the ounty of Burnett relying on this information I am � m <br /> providing in this application. I agree to permit c officials charg d with administering county ordinances or other v <br /> authorized person to hacce to the Ib <br /> scri d premises at ny reasonable time f the purpose of inspection. m Cn <br /> o <br /> CD <br /> CD <br /> SIGN HERE <br /> (signature of own r or buil ng c tract <br /> ate) <br /> ZONING ADMINISTRATOR 1 (w <br /> EA EA EA 69 N <br /> NN N 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED U10 0 (T (P 00 <br />